Some Patients Are More Equal Than Others: Variation in Ventilator Settings for Coronavirus Disease 2019 Acute Respiratory Distress Syndrome.

Autor: Dam TA; Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., de Grooth HJ; Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., Klausch T; Department of Clinical Epidemiology, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., Fleuren LM; Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., de Bruin DP; Pacmed, Amsterdam, The Netherlands., Entjes R; Department of Intensive Care, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands., Rettig TCD; Department of Intensive Care, Amphia Ziekenhuis, Breda, The Netherlands., Dongelmans DA; Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Amsterdam, The Netherlands., Boelens AD; Department of Anesthesiology, Antonius Ziekenhuis Sneek, Sneek, The Netherlands., Rigter S; Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands., Hendriks SHA; Department of Intensive Care, Albert Schweitzerziekenhuis, Dordrecht, The Netherlands., de Jong R; Department of Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands., Kamps MJA; Department of Intensive Care, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands., Peters M; Department of Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands., Karakus A; Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands., Gommers D; Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands., Ramnarain D; Department of Intensive Care, ETZ Tilburg, Tilburg, The Netherlands., Wils EJ; Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands., Achterberg S; Department of Intensive Care, Haaglanden Medisch Centrum, Den Haag, The Netherlands., Nowitzky R; Department of Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands., van den Tempel W; Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands., de Jager CPC; Department of Intensive Care, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands., Nooteboom FGCA; Department of Intensive Care, Laurentius Ziekenhuis, Roermond, The Netherlands., Oostdijk E; Department of Intensive Care, Maasstad Ziekenhuis Rotterdam, Rotterdam, The Netherlands., Koetsier P; Department of Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands., Cornet AD; Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands., Reidinga AC; Department of Intensive Care, SEH, BWC, Martiniziekenhuis, Groningen, The Netherlands., de Ruijter W; Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands., Bosman RJ; Department of Intensive Care, OLVG, Amsterdam, The Netherlands., Frenzel T; Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands., Urlings-Strop LC; Department of Intensive Care, Reinier de Graaf Gasthuis, Delft, The Netherlands., de Jong P; Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands., Smit EGM; Department of Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands., Cremer OL; Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands., Mehagnoul-Schipper DJ; Department of Intensive Care, VieCuri Medisch Centrum, Venlo, The Netherlands., Faber HJ; Department of Intensive Care, WZA, Assen, The Netherlands., Lens J; Department of Intensive Care, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands., Brunnekreef GB; Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands., Festen-Spanjer B; Department of Intensive Care, Ziekenhuis Gelderse Vallei, Ede, The Netherlands., Dormans T; Department of Intensive Care, Zuyderland MC, Heerlen, The Netherlands., Dijkstra A; Department of Intensive Care Medicine, Het Van Weel-Bethesda Ziekenhuis, Dirksland, The Netherlands., Simons B; Department of Intensive Care, Bravis Ziekenhuis, Bergen op Zoom en Roosendaal, The Netherlands., Rijkeboer AA; Department of Intensive Care, Flevoziekenhuis, Almere, The Netherlands., Arbous S; Department of Intensive Care, LUMC, Leiden, The Netherlands., Aries M; Department of Intensive Care, MUMC+, University Maastricht, Maastricht, The Netherlands., Beukema M; Department of Intensive Care, Streekziekenhuis Koningin Beatrix, Winterswijk, The Netherlands., Pretorius D; Department of Intensive Care Medicine, Hospital St Jansdal, Harderwijk, The Netherlands., van Raalte R; Department of Intensive Care, Tergooi Hospital, Hilversum, The Netherlands., van Tellingen M; Department of Intensive Care Medicine, afdeling Intensive Care, ziekenhuis Tjongerschans, Heerenveen, The Netherlands., Gritters van den Oever NC; Department of Intensive Care, Treant Zorggroep, Emmen, The Netherlands., Lalisang RCA; Pacmed, Amsterdam, The Netherlands., Tonutti M; Pacmed, Amsterdam, The Netherlands., Girbes ARJ; Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., Hoogendoorn M; Department of Computer Science, Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, VU University, Amsterdam, The Netherlands., Thoral PJ; Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands., Elbers PWG; Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Critical care explorations [Crit Care Explor] 2021 Oct 14; Vol. 3 (10), pp. e0555. Date of Electronic Publication: 2021 Oct 14 (Print Publication: 2021).
DOI: 10.1097/CCE.0000000000000555
Abstrakt: Objectives: As coronavirus disease 2019 is a novel disease, treatment strategies continue to be debated. This provides the intensive care community with a unique opportunity as the population of coronavirus disease 2019 patients requiring invasive mechanical ventilation is relatively homogeneous compared with other ICU populations. We hypothesize that the novelty of coronavirus disease 2019 and the uncertainty over its similarity with noncoronavirus disease 2019 acute respiratory distress syndrome resulted in substantial practice variation between hospitals during the first and second waves of coronavirus disease 2019 patients.
Design: Multicenter retrospective cohort study.
Setting: Twenty-five hospitals in the Netherlands from February 2020 to July 2020, and 14 hospitals from August 2020 to December 2020.
Patients: One thousand two hundred ninety-four critically ill intubated adult ICU patients with coronavirus disease 2019 were selected from the Dutch Data Warehouse. Patients intubated for less than 24 hours, transferred patients, and patients still admitted at the time of data extraction were excluded.
Measurements and Main Results: We aimed to estimate between-ICU practice variation in selected ventilation parameters (positive end-expiratory pressure, Fio 2 , set respiratory rate, tidal volume, minute volume, and percentage of time spent in a prone position) on days 1, 2, 3, and 7 of intubation, adjusted for patient characteristics as well as severity of illness based on Pao 2 /Fio 2 ratio, pH, ventilatory ratio, and dynamic respiratory system compliance during controlled ventilation. Using multilevel linear mixed-effects modeling, we found significant ( p ≤ 0.001) variation between ICUs in all ventilation parameters on days 1, 2, 3, and 7 of intubation for both waves.
Conclusions: This is the first study to clearly demonstrate significant practice variation between ICUs related to mechanical ventilation parameters that are under direct control by intensivists. Their effect on clinical outcomes for both coronavirus disease 2019 and other critically ill mechanically ventilated patients could have widespread implications for the practice of intensive care medicine and should be investigated further by causal inference models and clinical trials.
Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.
(Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze: MEDLINE
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